The future of health policy is at the forefront of this engaging conversation between Jesse Hirsh and Greg Vigdor, as they explore the pressing issues surrounding access to healthcare and the implications of emerging medical technologies. Vigdor emphasizes the stark reality of healthcare inequality, especially in the context of high-cost treatments like cancer therapies and the potential societal fallout from unequal access. They delve into the complexities of healthcare systems, discussing how the COVID-19 pandemic has exacerbated existing fractures and mistrust within these systems. The episode also touches on the pivotal role of storytelling and fiction in making health policy more accessible to the public, fostering engagement and understanding. As they navigate the challenges and opportunities within healthcare, they highlight the need for a shift towards patient-centered care and the importance of community in rebuilding trust in health systems.
The conversation between Jesse Hirsh and Greg Vigdor is a deep exploration of the challenges and opportunities within health policy, particularly as it relates to new medical technologies and their accessibility. Vigdor highlights a critical tension in the healthcare system: while advancements such as Ozempic and WeGovy hold the potential to revolutionize treatment for chronic conditions, they also raise significant questions about who gets access to these life-altering therapies. The discussion emphasizes the urgent need for a more equitable healthcare system, one where the benefits of scientific progress are available to all, not just the privileged few. Vigdor calls for public engagement and advocacy to ensure that health policy reflects the needs and rights of patients, thus fostering a more inclusive dialogue around healthcare.
The dialogue also delves into the implications of recent political developments in health policy, particularly the nomination of figures like RFK Jr. Vigdor expresses his concerns regarding the contradictions presented by such political figures, who may advocate for important health issues while simultaneously rejecting established medical science. This tension speaks to a broader crisis of trust in health authorities and the need for a societal shift towards evidence-based discussions about health policy. The conversation serves as a crucial reminder of the importance of informed public discourse, urging listeners to become advocates for change in the healthcare landscape.
Towards the end of the episode, Vigdor introduces a provocative idea: a national healthcare lottery to address the disparities in access to high-cost medical treatments. This radical suggestion serves to challenge listeners' perceptions of healthcare access and equity, highlighting the often arbitrary nature of how medical resources are allocated. Through their engaging dialogue, Hirsh and Vigdor illuminate the critical issues facing health policy today and inspire listeners to rethink the structures that govern healthcare access and equity.
Takeaways:
https://gregvigdor.com/
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Hi, I'm Jesse Hirsch.
Jesse Hirsch 00:00:03
Welcome to Metaviews, recorded live in front of an automated audience.
Jesse Hirsch 00:00:12
And today we're going to speak about what I think is a rather pressing issue, which is the future of health policy.
Jesse Hirsch 00:00:20
You know, paradoxically, here at mediviews, we talk a lot about policy because, of course, we try to engage people in an inclusive, participatory reflect when it comes to policy.
Jesse Hirsch 00:00:33
But healthcare policy is often even more difficult to engage, folks, even though it's something we are all engaged in, something we all have a stake in, something we should all, quite frankly, take more interest in.
Jesse Hirsch 00:00:47
So I say this, Greg, because we start every Metaviews episode with the news.
Jesse Hirsch 00:00:53
This is partly because Metaviews publishes a daily newsletter.
Jesse Hirsch 00:00:58
Today's issue actually deals with the crackdown on immigration policy and speculating that that might impact food security and the food supply chain.
Jesse Hirsch 00:01:09
Especially in California.
Jesse Hirsch 00:01:10
We're hearing reports of high levels of absenteeism where people are just not showing up to work because they don't want to take the chance of, you know, getting into trouble with the law.
Jesse Hirsch 00:01:21
But usually in our news segment, Greg, this is where we throw to our guest and say, is there any news that you're following?
Jesse Hirsch 00:01:27
Is there?
Jesse Hirsch 00:01:28
This could be local news, this could be world news, this could be health news.
Jesse Hirsch 00:01:33
And it's really meant as a way to sort of find out what our guest is looking at, but in particular, ask them, what do you think our audience should be paying attention to?
Greg 00:01:44
Yes.
Greg 00:01:45
Well, first, thanks for having me on, Jesse.
Greg 00:01:47
Appreciate being with you.
Jesse Hirsch 00:01:49
My pleasure.
Greg 00:01:49
And for the news, there's so much of it, it's a bit overwhelming.
Greg 00:01:54
So I just tried to figure out whether I wanted to take a big picture view or I thought I'm just going to go a little bit more localized as far as an issue goes and some of the compelling, huge stories going on around, you know, Trump and appointments, things like that.
Greg 00:02:09
It's semi glutides, okay, drugs, Ozempic, WeGovy, that offer that might be the miracle drugs of the 21st century.
Greg 00:02:19
And there's so much of healthcare that's just like that, that offering tremendous promise for making just incredible changes in the trajectory of human life and experience.
Greg 00:02:32
And then meanwhile, we're in the middle of questions about who gets it and how and when and if and for how much.
Greg 00:02:40
And some of this was going on today is actually around compound pharmacies and will some of the emergencies that were declared that allowed some version of those substances to get to more people because there wasn't enough of Them, well, maybe that's not going to be allowed to happen anymore.
Greg 00:02:55
And what does that mean?
Greg 00:02:56
And who's going to get this stuff?
Greg 00:02:58
And just, I think represents just a whole number of other areas of human development that we have to figure out.
Greg 00:03:05
The social questions about how we get this stuff to people and is it fair or is it the type of stuff that will tear apart societies because it is so unfair?
Jesse Hirsch 00:03:16
Right on.
Jesse Hirsch 00:03:16
That's a fantastic way to frame it.
Jesse Hirsch 00:03:18
And you know, when I initially booked you, I sort of mentioned that, you know, I'm Canadian and many of our listeners are Canadian.
Jesse Hirsch 00:03:25
But to your point, one of the wrinkles of Canadian healthcare, of course, is drugs and prescription drugs in that they are not often covered, it's the end user, the patient who has to provide the cost.
Jesse Hirsch 00:03:38
So we have similar debates, especially around some of the emerging really powerful medicines that can be expensive.
Jesse Hirsch 00:03:45
Right.
Jesse Hirsch 00:03:45
And whether they are covered under our provincial health plans or our provincial drug plans.
Jesse Hirsch 00:03:51
So I agree with you, these are really important debates, especially given the power, the healing effects, the quality of life changes.
Jesse Hirsch 00:03:59
But you did sort of allude at the start there, as you were kind of brainstorming what you were gonna answer.
Jesse Hirsch 00:04:04
I will ask a completely different follow up question still within our topic of the news.
Jesse Hirsch 00:04:10
Cuz while we're recording this on Tuesday, it'll probably be released on Wednesday, which happens to be the nomination hearing for RFK Jr.
Jesse Hirsch 00:04:20
In terms of what is the exact cabinet position?
Jesse Hirsch 00:04:24
Is it Secretary of Health, is that correct?
Greg 00:04:27
Yes, the primary federal agency for health and running its massive federal agency.
Jesse Hirsch 00:04:33
And he is obviously a controversial, polarizing, if not terrifying figure to run to have such office.
Jesse Hirsch 00:04:42
I'm curious whether you have any comments or thoughts on either the nomination process or what happens if, if he ends up becoming the secretary.
Greg 00:04:51
I think I have, like most Americans, a lot of bewilderment and confusion over the whole thing.
Greg 00:04:56
For me, when I look at it, he's such a contradiction because on the one hand he rejects, you know, hundreds of years of medical science around things as basic as social distancing and vaccines.
Greg 00:05:10
And you're in terror of going back to the dark ages of how we dealt with infectious diseases because of that.
Greg 00:05:17
And then meanwhile he jumps onto another issue, which is one that most Americans, including me, looked at.
Greg 00:05:23
Well, we're never going to do anything about that, which is the horrible problem of what's in our food, food additives and subsidies that go into why that is the case.
Greg 00:05:31
And he says he wants to tackle that.
Greg 00:05:33
And that's what's going to be what's going to make America healthy again.
Greg 00:05:36
And you know, there's authors that have approached that, but very few politicians that even breathe those words.
Greg 00:05:41
And you go, well, what do I think of that?
Greg 00:05:44
That could be amazing.
Greg 00:05:45
But if it's at the choice or the cost of no longer having vaccines for the childhood ailments that killed half of the globe just 100 years ago, that's probably not a bet worth making.
Jesse Hirsch 00:05:57
It is an interesting Faustian bargain, and I'm not convinced that he could deliver on industry reform or sort of changing the way that food is produced at scale.
Jesse Hirsch 00:06:10
But hopefully this is me looking for the silver lining.
Jesse Hirsch 00:06:13
Hopefully it encourages people to think about health policy.
Jesse Hirsch 00:06:16
Hopefully it encourages people to think, hey, maybe this is something in a democratic society we should be paying more closer attention to and engaging.
Jesse Hirsch 00:06:25
Now, our second segment on every meta views we call WTF or what's the Future?
Jesse Hirsch 00:06:33
And it's partly because we are a future centric podcast, but also because we like our guests to kind of share what's on their event horizon.
Jesse Hirsch 00:06:42
And your news answer was, to your credit, kind of future centric.
Jesse Hirsch 00:06:45
I mean, granted, it dealt with the present in terms of some of the medicines that are available and the policies around access.
Jesse Hirsch 00:06:52
But you were alluding to really the impact they could have if they were as widely available, if we had perhaps even greater literacy so people understood the options.
Jesse Hirsch 00:07:03
I've given you enough time to brainstorm an answer.
Jesse Hirsch 00:07:06
What do you see in the future?
Jesse Hirsch 00:07:08
What are you looking at that you think our audience should know more about?
Greg 00:07:12
Well, when I first heard the wtf, I thought it was something else, but I could still use the same same heading for it.
Greg 00:07:21
It still is the possibilities of future.
Greg 00:07:22
I'm an optimist, maybe cursed by that.
Greg 00:07:25
So I do tend to think of what's going on technologically around and some of the other systems around health and what we're showing is possible.
Greg 00:07:32
But I think I'm as troubled by the what I said earlier about what happens if we don't do this right, and the possibility that it is actually inequality around health and the expectation of life that can really just destroy the fabric that is our society.
Jesse Hirsch 00:07:50
Do you want to elaborate on that a bit?
Jesse Hirsch 00:07:52
And I say that because I think you and I sort of understand the dynamics of that equality of that perhaps impact on longevity.
Jesse Hirsch 00:08:01
But elaborate on the social dynamics, the social impact in terms of, to your point, people being really upset and alienated when this kind of medicine is not accessible and equitable.
Greg 00:08:12
All right, well, let's take it out of the example I started with at the beginning, because that's still more about diabetes and weight management and that's more of chronic disease management, which might not be as persuasive.
Greg 00:08:23
To make my point, let's take it to cancer.
Greg 00:08:26
Some pick your deadly cancer.
Greg 00:08:28
And there are technologies out there that have been developing, especially over the last decade, even the last five years, that are showing incredible promise to cure a variety of cancers.
Greg 00:08:38
Many of these are prescription drug based.
Greg 00:08:42
These doses run sometimes as much as $30,000 a dose, which you receive maybe every month or every other month, just an incredible amount of money.
Greg 00:08:53
And so if you're going to say that, well, who gets that?
Greg 00:08:56
You know, there's not going to be enough of that to go around.
Greg 00:08:59
And who gets it?
Greg 00:09:00
And if it's just all the really wealthy people, is that going to be something that the people that don't have all that money would say, well, that's okay, I appreciate they got a lot of money so they should be allowed to live.
Greg 00:09:12
Or is it going to be those that control the government or control your church or.
Greg 00:09:18
I mean, you can go through so many devices.
Greg 00:09:21
I do think that for me, the emerging issue of the ages in health policy is about control, not money.
Greg 00:09:29
The systems in America, these health systems are getting bigger and bigger.
Greg 00:09:32
It's not like they need more money, they want more control.
Greg 00:09:35
And so this, when you start talking about control, you start talking about how people look at a society and accept it or not.
Greg 00:09:42
And for many years, and I probably say as an American, we've accepted the benefits and the limits of our model, but I could see it already starting to fray and this is where I would expect it to go at its worst.
Jesse Hirsch 00:09:56
Well, and also I think the emotions that we tend to ascribe to healthcare, we tend to ascribe to our health, to the well being of our family members, is an incendiary dynamic to what you describe, right?
Jesse Hirsch 00:10:08
That when you start losing loved ones, when you start losing family members, I think that's when people really get upset.
Jesse Hirsch 00:10:15
Now, I like to structure sort of each interview we have here on Metaview.
Jesse Hirsch 00:10:20
This is Prez, our turkey coming in to roost.
Jesse Hirsch 00:10:24
Sort of describing our feature interview around kind of three pillars.
Jesse Hirsch 00:10:28
I tend to look at the guest and I take three themes that I want to wrap the conversation around.
Jesse Hirsch 00:10:34
And in our case, I thought it would be healthcare pandemics and policy.
Jesse Hirsch 00:10:39
Right.
Jesse Hirsch 00:10:39
As sort of three ways, hopefully that we can get into some really interesting ideas and conversation because what you were just describing there kind of again, Reminded me of what it's like to be a Canadian looking at the US Healthcare system.
Jesse Hirsch 00:10:54
Because on the one hand, we like to tell ourselves at least we won't be bankrupted if we get cancer, or at least a trip to the emergency room isn't going to be a big hit.
Jesse Hirsch 00:11:06
But on the flip side, we see such a gap between the high end and the low end of American medicine that the high end is really exceptional.
Jesse Hirsch 00:11:16
Like if you look at elite American medicine, elite American medical research, it's really quite impressive and I think to what you're describing, that if that gap between the top and the bottom becomes so extreme, is there a threat of the system breaking as a whole, right of there just being such a gap between what is available to the wealthy and what is available to everyone else?
Jesse Hirsch 00:11:42
To what extent is that already happening?
Jesse Hirsch 00:11:44
To what extent is there already a kind of breeding resentment or a frustration that people can't get the care that they require?
Greg 00:11:53
Yes, it's been breeding for quite a while and it actually used to be a lot worse.
Greg 00:11:57
Just go back about 20 years passed what we call the Affordable Care act or Obamacare, depending how one likes to look at it.
Greg 00:12:05
And what that reflected was U.S.
Greg 00:12:07
policy, which was we had this incredibly high end level of care for people that were in the system.
Greg 00:12:13
But and I have traveled around the globe and looked at other health systems and one of the defining things about the American system is the opposite of that, which is we had so many people that were outside of the system.
Greg 00:12:24
We called them the uninsured, but there were even more underinsured.
Greg 00:12:28
So there's just millions and millions of Americans who were left out of the system entirely, where all the great things that were going on.
Greg 00:12:37
And so a lot of our work as Americans trying to make our system better was trying to address how we deal with those gaps.
Greg 00:12:44
Well, most of our efforts went by the wayside.
Greg 00:12:48
We couldn't politically get them there.
Greg 00:12:49
But the Affordable Care act, not a perfect piece of legislation in my mind at all.
Greg 00:12:53
But the one thing it did do is actually finally close the gap of the uninsured by creating a number of different structural ways to get more people into the system.
Greg 00:13:01
And at least the high end contention over the system started to tamp down a bit.
Greg 00:13:07
And it has and it's continued because it through the first Trump administration, they wanted to kill that, but didn't, couldn't.
Greg 00:13:14
And then Biden reinforced a lot of those pieces, sometimes, well, sometimes poorly.
Greg 00:13:21
But again, it was not completely out of whack.
Greg 00:13:23
And there's still way fewer, way fewer uninsured Americans than there were going back into the 1990s.
Greg 00:13:30
And that has been sort of one of the key characteristics of our system.
Greg 00:13:33
And weakness.
Greg 00:13:34
Well, you don't have to go very far to extrapolate on just the discussions that are going on in Washington, D.C.
Greg 00:13:40
right now to look where that might actually be.
Greg 00:13:43
The good old days, meaning the 90s.
Greg 00:13:46
Right.
Greg 00:13:47
And I do suspect that it really will start to stretch our ability to keep it together.
Greg 00:13:51
Because again, what I'm saying is that meanwhile, medicine has moved on into what might be a new age of incredible development.
Greg 00:14:00
And so that gap only becomes bigger as more and more people are unable to access those benefits.
Jesse Hirsch 00:14:06
Although let me throw you a curveball which is to what extent are people aware of the benefits?
Jesse Hirsch 00:14:11
Like as patients, you almost have a certain literacy to know, to ask about something like Ozempic, to have a certain level of patient advocacy or someone in your family advocating on behalf of you.
Jesse Hirsch 00:14:25
And it strikes me that it's not just about access to medicine, but access to the knowledge to know how to ask for that medicine.
Jesse Hirsch 00:14:33
Is that also a problem when you're sort of relying upon privatized means of educating people around their own healthcare and their own healthcare options?
Greg 00:14:42
I think it's a short term problem.
Greg 00:14:44
I think there's a lot of Americans don't have a clear idea of what's going on in the revolution in American and worldwide thought about health care.
Greg 00:14:52
But it's only going to be for so long.
Greg 00:14:54
You can't keep things like curing cancer sort of secret.
Jesse Hirsch 00:14:58
Yeah.
Greg 00:14:58
You can pin media all you want or not allow government officials to say it.
Greg 00:15:03
I have a feeling that word's going to get out.
Jesse Hirsch 00:15:05
Yeah, well, I mean, as a tangent to that, you know, stem cell therapy, it strikes me as sort of its own kind of revolution.
Jesse Hirsch 00:15:13
But it's obviously nowhere near accessible in terms of the average patient.
Jesse Hirsch 00:15:19
Do you think that that's a peril?
Jesse Hirsch 00:15:21
Cancer's a big one because it touches so many people and the media would be all over it.
Jesse Hirsch 00:15:25
It would be such a sensational title.
Jesse Hirsch 00:15:27
But it strikes me that what's happening with stem cell therapy is widespread in wealthy circles.
Jesse Hirsch 00:15:34
If you know, you know.
Jesse Hirsch 00:15:36
But I don't know a lot of people who understand or even know the word stem cells or the impact that it could have.
Jesse Hirsch 00:15:43
I'm curious if you see that as an analogy or perhaps an aberration.
Greg 00:15:47
I think it's a good one.
Greg 00:15:48
As you get into some of the more isolated piece of this, it's more Technologically, most of this stuff I barely understand.
Greg 00:15:54
I'm not a scientist.
Greg 00:15:55
I just sort of grasp it enough in concepts to be able to manage it.
Greg 00:15:58
But the one thing that does equalize all this is that more and more what's happening is people are having to take care of their relatives and friends and loved ones on their own.
Greg 00:16:08
We used to just be able to ship them off to nursing homes and go visit them once a year or twice a year.
Greg 00:16:14
Well, that's not going to be the model much longer.
Greg 00:16:16
It already is breaking down.
Greg 00:16:18
And the more you have to actually see the misery and the difficulty of caring for those folks, I think that's going to counterbalance whatever areas of ignorance people might have about that.
Greg 00:16:27
As soon as they see that, they might start asking even more questions and maybe want to understand.
Jesse Hirsch 00:16:32
Well, and perhaps then another area like cancer that kind of touches everyone eventually is cognitive decline.
Greg 00:16:40
Yes, that's exactly what I was thinking of.
Jesse Hirsch 00:16:42
And the extent to which there are now drugs that can treat Parkinson's, that can treat early Alzheimer's, that are again, expensive and not necessarily accessible, yet we are, I think, in our families, in our communities, going to have contact with people who are experiencing dementia or who are having that kind of cognitive decline again, where.
Greg 00:17:04
And my semi pluto example from the beginning is that some of the research is out there is suggesting that those semi glutides might have a profound impact on exactly those diseases.
Jesse Hirsch 00:17:14
Well, and to your point about anticipating the transformation of elder care and the transformation of retirement homes, do you see similar changes when it comes to institutions and how healthcare is delivered?
Jesse Hirsch 00:17:28
And I say this in the sense that it felt to me the 20th century was about bricks and mortar, about hospitals, but the potential now is perhaps more community clinic or perhaps more even home care.
Jesse Hirsch 00:17:40
If we were to fantasize of some utopia, do you see that kind of happening either in a good way or a bad way, in terms of how healthcare is either falling apart or transforming itself, depending on your perspective?
Greg 00:17:55
Well, I do see the institutional base of healthcare being bricks and mortar, kind of reconceptualizing itself, but that's not necessarily good because it's mostly reconceptualizing itself, not for the care of the patient, but for the benefit of the systems that profit from it primarily.
Greg 00:18:15
So at some level the two intersect.
Greg 00:18:17
But I would say a lot of the current innovation is really about how to control the costs of the system and the providers and to make it convenient and manageable for them, not for the individuals that are going to be affected by it there's one change into American health policy that I would advocate for and have been advocating for most of my career.
Greg 00:18:37
It's to build the system around the patients and the people, not the medical providers and the insurers and the government.
Greg 00:18:43
And we continue to do exactly the opposite.
Jesse Hirsch 00:18:46
Right on.
Jesse Hirsch 00:18:47
And I want to come back to that sort of subject of patient centric care, even better, you know, patient managed healthcare systems.
Jesse Hirsch 00:18:54
But let me take a quick and relevant tangent to talk about your use of fiction and the way in which you use storytelling and you use fiction as a way to make these subjects accessible.
Jesse Hirsch 00:19:07
I'm a policy wonk.
Jesse Hirsch 00:19:08
So right away we started into our conversation.
Jesse Hirsch 00:19:11
I was like, well what about RFK Jr.
Jesse Hirsch 00:19:12
What about this?
Jesse Hirsch 00:19:13
But most people, they may not feel as comfortable getting into the weeds that way.
Jesse Hirsch 00:19:19
So talk a little bit about the way in which you've used fiction and storytelling as, you know, a more accessible way to get people interested in these issues.
Greg 00:19:29
Yes.
Greg 00:19:29
So I spent a 40 plus year career working in the policy world trying to change things and doing some good.
Greg 00:19:36
And when I sort of stepped aside from my last big job and looked at everything, I said, you know, the system is still screwed up and I'd like to find some other ways to get through.
Greg 00:19:46
And I said, but I want to try to do it a different way.
Greg 00:19:49
And I said, well, I think I still want to do the same things, which is try to convince the public will that they want a different system and engage them.
Greg 00:19:55
And I'm going like, well, I also have 40 years of experience in knowing that not that many people really want to talk about this or explore it.
Greg 00:20:02
So I said, well, I've always wanted to write a book novel.
Greg 00:20:06
And that's sort of where the two things came together.
Greg 00:20:08
The notion of just sort of using entertainment as a way to get people to engage, flip your messages in around fun and entertainment, even if it's as explosive a topic as healthcare.
Greg 00:20:21
Is there a way to do that?
Greg 00:20:23
And my three books so far have been experiments about whether I can kind of put the two things together.
Greg 00:20:27
And I continue to believe it's possible.
Greg 00:20:29
Whether these are the perfect books or not yet I'm not sure, but I'll let the readers gauge that.
Greg 00:20:34
But so far of engaging people and now I'm even encouraged because.
Greg 00:20:40
And you can't make up reality.
Greg 00:20:43
It's things like what's going on in the Trump administration or the assassination of insurance executive on the streets of Manhattan.
Greg 00:20:50
I mean, suddenly the crazy stuff in my books doesn't seem so crazy.
Jesse Hirsch 00:20:55
Quite the opposite.
Jesse Hirsch 00:20:56
It probably increases the appetite for these types of stories and allows this kind of second or third career as an authority to have a lot of Runway right because you can't make this stuff up.
Jesse Hirsch 00:21:10
And yet that allows you as an author to get even deeper into it.
Jesse Hirsch 00:21:14
And I wanted to use the role of fiction and the role of storytelling as a kind of segue to talk about pandemics because I would say a lot of people still have a lot of trauma associated with the COVID pandemic.
Jesse Hirsch 00:21:31
And as someone who watches the news, I've got my eyes on a potential avian flu pandemic, which I sure hope doesn't happen.
Jesse Hirsch 00:21:39
But nonetheless, the epidemiologists are going, hey, let's keep an eye here.
Jesse Hirsch 00:21:45
So I'm curious on first, the health policy level, to what extent did America's experience with COVID ongoing cause of course it's not over.
Jesse Hirsch 00:21:55
How has that made health policy complicated?
Jesse Hirsch 00:21:59
And I'm obviously being a little facetious when I say complicated.
Jesse Hirsch 00:22:03
Totally fucked up is perhaps another way to phrase it.
Jesse Hirsch 00:22:07
But again, as someone who has a multi decade career in health policy, give me your sense of what the pandemic did to the way in which these health debates and these policy debates happen.
Greg 00:22:20
Yeah.
Greg 00:22:21
So this would be the session you show that I would say is WTF for certainly America, but even the globe.
Greg 00:22:29
Because it really was this change of.
Greg 00:22:31
We have experts who are out there trying to help us stay healthy that are going to work on issues like pandemics.
Greg 00:22:37
And suddenly they became the enemy.
Greg 00:22:40
Not to be trusted, but even the enemy.
Greg 00:22:42
And suddenly we were looking for answers in our ideologies, in our politicians, in profiteers, in crazy snake oil salesmen who had a microphone.
Greg 00:22:55
It was just mind boggling to me.
Greg 00:22:57
A huge part of my career has been sort of being ready for exactly the types of things that happen.
Greg 00:23:03
Avian flus and these viruses that will mutate.
Greg 00:23:08
My last job was I was the CEO of the Arizona Hospital Association.
Greg 00:23:12
One of the things I brought to that association was trying to coordinate all the hospitals and with the state government and other medical facilities and providers, how do we respond to exactly something like what happened?
Greg 00:23:23
And there's, I thought that's about when I left my job saying, well, we should be ready, we should be ready in America, because I know some of the plans we have for these things.
Greg 00:23:33
And with all those things in place, that's not what we did.
Greg 00:23:38
And then when it got hopelessly fucked up, the, of course what actually happened became a whole different thing because it's who you were listening to.
Greg 00:23:45
And it was sort of just crazy talk.
Greg 00:23:47
But my second book is called the COVID Murders and it really wasn't so much about COVID It was just to reflect upon a time period where everything just went off the rails entirely and nothing made sense.
Greg 00:23:58
And.
Greg 00:24:00
But we still.
Greg 00:24:01
Those threads are still there.
Greg 00:24:03
If not, they're probably even worse.
Greg 00:24:05
It's where you get the RFK side that denies vaccines, as if somehow the COVID vaccine was a dangerous vaccine, which it isn't and wasn't beneficial, which it was.
Greg 00:24:16
And that we still have this whole reality, certainly in America, that believes that it was the problem.
Greg 00:24:24
And it's sort of hard to move forward when you have so many people in these isolated pockets where they don't really talk.
Greg 00:24:31
So again, can art and books help bring people together?
Greg 00:24:34
I hope.
Greg 00:24:35
But that might be something that requires something more, which is a rediscovery of trust in society that transcends, I think, anything I've sort of dealt with in my career.
Jesse Hirsch 00:24:45
Although part of what we sort of deal with on meta views is the role of storytelling and trust building, right.
Jesse Hirsch 00:24:52
That you can't really use the old school, top down lecture mode.
Jesse Hirsch 00:24:56
You have to create stories that people enter on their own accord.
Jesse Hirsch 00:25:00
And in that story, in that journey, then they realize, oh wait, it's not the vaccine that created all that damage, it was Covid that created all that damage.
Jesse Hirsch 00:25:10
Right.
Jesse Hirsch 00:25:10
Because it is a kind of displaced blame.
Jesse Hirsch 00:25:12
They're blaming the vaccine for what the disease itself is kind of unleashing.
Jesse Hirsch 00:25:17
But allow me then to throw you a very difficult policy question which because you are now in a kind of semi retired or fictional position, you can answer this without the constraints of a contemporary decision maker.
Jesse Hirsch 00:25:32
But in the wake of that shit show that we experienced, what do you see as pandemic preparedness now?
Jesse Hirsch 00:25:40
It feels that so many of the options that we would have imagined before COVID when it comes to how we handle a pandemic, how we have again, preparedness, it feels a lot of those options are just not available because of not just the misinformed public, but a falsely politicized public that adds all sorts of extra constraints to public health officials who are charged with anticipating what to do when this happens again.
Greg 00:26:11
Yes.
Greg 00:26:12
So two part answer.
Greg 00:26:13
My first answer is prayer as policy, because I don't think we're ready.
Greg 00:26:17
I don't think we could safely make it through something of that proportions.
Greg 00:26:21
And, and the truth is Covid actually wasn't the big one.
Greg 00:26:26
It turned out to be somewhat benign relative to what we thought it could be.
Greg 00:26:33
So if something worse, I mean, just can't even imagine it, you're not, I mean, right now the CDC is not allowed to talk to the public in the United States.
Greg 00:26:42
The United States is not allowed to be part of the World Health Organization order of failings.
Greg 00:26:46
It has.
Greg 00:26:47
But can you somehow have an infrastructure that can respond to viral disease spread if you're not even talking?
Greg 00:26:54
I don't think so.
Greg 00:26:56
So I'm just terrified by the possibility.
Greg 00:26:59
The other one gets the optimist side of me of looking at the potential of social breakdown.
Greg 00:27:04
I would like to believe that it just can't sustain if that becomes the case, that somehow these ridiculous political and ideological divides have to go away in the interest of sanity and the preservation of the human species.
Jesse Hirsch 00:27:17
Well, and let's use that then as a way to imagine the alternative.
Jesse Hirsch 00:27:22
Because where I do see that kind of justice coming is a patient led model, A patient centric model.
Jesse Hirsch 00:27:30
And as crazy, as insane as the current regime's approach to health policy is, the light at the end of the tunnel is the more that patients suffer, the more that patients or families and advocates of patients experience these bad outcomes, the more likely they are to organize, the more likely they are to be vocal and get around that.
Jesse Hirsch 00:27:54
So again, on the policy level, as a policy question, and let's go short term here before we go long term, what are the low hanging fruit that could help us shift towards a patient centric system that could help us shift, and I don't even mean on a governance level, I really just mean initially on a cultural level, get to a point where we're putting patients at the center and recognizing that that's where we start building a system around the needs, the concerns, the identities of the patient themselves.
Greg 00:28:31
Right?
Greg 00:28:32
Well, as a short term proposition, I would say the only place really to go is to try to build within the American somewhat it's a global thing, but American certainly tradition around community organizations that if you really want to find where trust is the greatest, it's when people are among those they perceive to be like them.
Greg 00:28:51
Whether that's geographic, more local communities, or whether it's around where you worship or don't, or clubs, bowling clubs, or you know, just it's getting into those units and somehow trying to atomize those smaller groups to say, you know, we get together to bowl some frames, but gee, maybe we should figure out how we don't get this pandemic that's going around the globe while we're here.
Greg 00:29:17
And that's what I would say somehow try to get it out to that level and maybe in all the other dysfunction and all the attacks, maybe that would be allowed to foster that believing in some cynical plan to disrupt the Trump revolution or whatever it might be.
Greg 00:29:32
So that's where I'd go there.
Greg 00:29:33
I think longer term, there's other ways to do it structurally.
Greg 00:29:36
I've had to posit some of these from my books, even where I try to come up with solutions to some of the problems I lay out.
Greg 00:29:43
So let me just give you one example.
Greg 00:29:45
National Institutes of Health in America is one of the leading, you know, conglomerates of research on the globe.
Greg 00:29:51
Well, even, even this week they're in paper because apparently the Trump administration is trying to push out people who have long term standing there, which could, you know, destroy a lot of research.
Greg 00:30:01
Yeah, I'm trying to think of something good about that.
Greg 00:30:03
Well, one of my proposals for how would you get American healthcare policy on track was to you should we should create another institute within the Institutes of Health, and that should be the institute, basically Patient Centered Care, where you have the best minds in America trying to figure out how you actually build what you just described.
Greg 00:30:21
And how would you set up the models where that's what would be recreated in communities and places around the country.
Greg 00:30:27
We would know how to do something that we already do know how to do some of that we just don't think about intentionally doing it.
Greg 00:30:33
Well, that could never happen with a lot of the Institutes of Health people there.
Greg 00:30:36
Maybe if everybody's gone, we can do that because it's circling completely open book.
Greg 00:30:40
I don't know, maybe that's not so optimistic.
Jesse Hirsch 00:30:43
But again, we're trying to find the phoenix in the ashes here.
Jesse Hirsch 00:30:47
Right.
Jesse Hirsch 00:30:48
Given that things are on fire.
Jesse Hirsch 00:30:50
But it also reminded me during the pandemic, or I shouldn't say during the pandemic, we're still in the pandemic.
Jesse Hirsch 00:30:55
During the lockdown part of the COVID pandemic, I spent a lot of time kind of connecting to the disability justice movements.
Jesse Hirsch 00:31:04
And, you know, when everyone was locked down, it certainly gave an increased visibility to people who experience disability because they're online often anyway, and they were in a position of quasi leadership.
Jesse Hirsch 00:31:17
To what extent can we, in trying to achieve what you're describing, how do we further destigmatize disability or how do we normalize disability in the sense that if we all live long enough, we're all going to be disabled at some point.
Jesse Hirsch 00:31:32
So rather than othering people who experience disabilities, how do we kind of Empower them to be the leaders of the kind of system that you're describing.
Jesse Hirsch 00:31:42
At the very least on a research level.
Jesse Hirsch 00:31:45
Right.
Jesse Hirsch 00:31:45
In terms of the way that we think about the types of participatory research models that are out there.
Greg 00:31:51
Yeah, that's a great idea.
Greg 00:31:52
I hadn't really thought about it that way.
Greg 00:31:54
I think we do have a lot to learn.
Greg 00:31:56
Usually we have these divisions because people are not really aware of people in those circumstances, whatever it is.
Greg 00:32:03
So mine again is find these communities and start to cross fertilize them.
Greg 00:32:07
And again, not global level national trade associations, but where they live and breathe and relate to each other.
Greg 00:32:15
And I suspect a lot of these things will break down just like Republicans and Democrats in our country.
Greg 00:32:20
I don't know how your divides work there, but the more you put people in a room, you know, we see the television shows where they're all fighting and yelling at each other, but my experience is still we try to find a way to be civil with those that don't really agree with us and even find times with those we want to be friends with.
Greg 00:32:37
A way to try to somehow have a conversation.
Greg 00:32:40
I think it's still the basic elements of being a human being might do what we want to draw on when we start to get eaten up by viruses.
Jesse Hirsch 00:32:47
Well, and we're kind of talking on a utopia level, dare I say it, when it comes to patients and practitioners.
Jesse Hirsch 00:32:54
But it struck me when you were saying that that even within medicine itself there's often not a lot of interdisciplinary talk or interprofessional collaboration.
Jesse Hirsch 00:33:05
There's still kind of silos and status within the healthcare milieu.
Jesse Hirsch 00:33:11
Have you thought about policies that try to address that, that try to foster more collaborative care and team based care?
Jesse Hirsch 00:33:19
Especially when dealing with an aging society where it's never one thing you're dealing with, it's the complications of multiple diagnosis that as we age, often make healthcare more complicated and more expensive.
Greg 00:33:34
Yes.
Greg 00:33:34
I would say for most of my career and even my first book, that was more the issue I was focused in on, which is the fragmentation of American medical care, why it got that way and how to solve it.
Greg 00:33:45
It got that way out of the very same thing that created its incredible growth, which was scientific discovery.
Greg 00:33:50
There's discovery around certain things that it actually helped to have.
Greg 00:33:55
Scientists and then physicians who organized by specialty to conglomerate around.
Greg 00:33:59
Well, it's those very threads that somehow took our system to such complex and inefficient plateaus that we couldn't put it back together.
Greg 00:34:08
So you kind of have to try to deal with that.
Greg 00:34:10
But all along there have been solutions out there.
Greg 00:34:12
Even going back to america in the 1920s, there was a study group that called the committee on the Committee on the Cost of Medical Care which was saying how do you somehow put the genie back in the bottle?
Greg 00:34:24
And one of their primary Recommendations out of 5 was Group Medical practice.
Greg 00:34:29
That instead of having these physicians and groups of specialties or individuals was more the case back when they wrote the report.
Greg 00:34:37
You actually somehow put them where they're working together as a team.
Greg 00:34:41
And many of that was rejected.
Greg 00:34:44
It's actually coming back in a different way now.
Greg 00:34:46
Bit too organized maybe by health systems who are employing them, which is a different model of trying to build collaboration than what I'm talking about.
Greg 00:34:54
But there's ways to do it.
Greg 00:34:56
And so yes, I think we can do that.
Greg 00:34:59
I think we have to do that if we want to get at the effectiveness and the efficiency questions.
Greg 00:35:04
We've been off more on the survivability questions, I think, than those, although the.
Jesse Hirsch 00:35:09
Survivability seems to be the pertinent issue given the current climate.
Jesse Hirsch 00:35:15
But as a tangent, I want to come back to the universality issue, but as a tangent and feel free to take a pass on this if you think it's either loaded or not in your wheelhouse.
Jesse Hirsch 00:35:26
But there's a lot of rhetoric around AI and healthcare.
Jesse Hirsch 00:35:30
Part of this rhetoric is the tech companies wanting to be in the healthcare space, wanting to, I would assume, get access to healthcare data and patient data.
Jesse Hirsch 00:35:40
But as someone who looks at healthcare from a meta view, right, From a system level, from a policy level, how much weight or how much substance do you put into some of these AI claims and AI potential when it comes to revolutionizing healthcare as we know it?
Greg 00:36:00
So this was almost my answer to your question about the news when I thought about it today, because I have been observing the AI phenomena quite a bit.
Greg 00:36:10
Even as an author, I'm seeing it pop up in some of classes and how we're supposed to deal with it too.
Greg 00:36:16
But my take on it is it's another one of those incredible tools out there that will contribute and maybe even greatly accelerate some of these scientific discoveries around cancer and other things that threaten our lives and experience when we are alive.
Greg 00:36:32
But what it mostly made me think of is much of my career I used to was blessed to be able to attend all these big conferences and the positions I held where I'd hear people get together and talk about what they can do to change the world.
Greg 00:36:45
And the last five, ten Years of my career, a lot of it was around this thing called big data where these big healthcare companies would come in and say we're buying up all the healthcare data and we're putting it together in these pools where just a handful of us, we'll be able to get at it and we're going to be able to change the world for the betterment of mankind.
Greg 00:37:04
And by the way, it'll help us out too.
Greg 00:37:07
Well, having watched all that for more than 10 years, I've watched earlier things which is around just computers and watching the same type of conversation about how we're going to make everything better for people in the world because we're going to take patient data and put it all together.
Greg 00:37:21
Well, the beneficial sides of that to humanity and systems never seems to show what mostly has showed the ability of man to somehow take things and profit from them.
Greg 00:37:32
So I'm highly suspicious of whether AI will be corralled such and controlled such that it will lead to the beneficial aspects more than the continuation of human greed and the ability to aggregate wealth.
Jesse Hirsch 00:37:48
Well, as an aside, I remember the same thing said about 5G, right?
Jesse Hirsch 00:37:52
That 5G was going to accomplish all that and all it did was increase our monthly bill.
Jesse Hirsch 00:37:57
Yeah, I did want to come back to the notion of universality.
Jesse Hirsch 00:38:02
And here in Canada, universality, while a bit of a myth compared to, or perhaps that's unfair, it's more aspirational.
Jesse Hirsch 00:38:12
Right.
Jesse Hirsch 00:38:12
It's something that we hold as a virtue or a value of our system, but when you get into the nuts and bolts, isn't always there.
Jesse Hirsch 00:38:20
And it strikes me that a lot of what we've been talking about today, whether it's the revolution in medicine, the potential of new organization of delivering medical care, let alone whether the patient is at the center or leading it, how is universality either focused on or moved towards within this larger policy framework?
Jesse Hirsch 00:38:45
Often that could be on an issue of just cost.
Jesse Hirsch 00:38:47
But I think we've been uncovering additional barriers than just cost when it comes to making healthcare universal, making access to healthcare universal.
Jesse Hirsch 00:38:57
So what do you look for when it comes to policy mechanisms or even policy ideals that help us put the attention back on universality at a moment in time when it feels like we're headed in the opposite direction?
Greg 00:39:11
Yes.
Greg 00:39:12
I've been spending a lot of time thinking about exactly this question, starting with, well, what is it about the universality, to use your term.
Greg 00:39:19
And I've tended now think about it more as what's fair.
Greg 00:39:24
And people can have different trips as fair, but it's just a statement.
Greg 00:39:27
It sort of captures sort of maybe the essence of it for me that it's fair that again people will accept it individually, collectively.
Greg 00:39:35
And so I've sort of more thrown out polemics and the crazy thing for me is one that I've been working on quite a bit in my books and I've used it just because I thought it would expose the question, but now I'm wondering if maybe it's the answer.
Greg 00:39:48
Is one of my policy prescripts in my first book for making the American health care system better was that one of the ten point part of the ten point plan one was that we would have a national healthcare lottery for those that couldn't buy these high end technologies that would save their life.
Greg 00:40:05
They could enter the lottery like we do for the financial lottery and everybody would get a draw to see if they're the one that gets the cancer drug or whatever it is.
Greg 00:40:15
And I was sort of semi serious, but I thought it would bring out the point and sort of force the conversation about what we might do.
Greg 00:40:22
Well, my most recent book is called Death Panels and the sub theme is really about the allocation of life saving technology.
Greg 00:40:30
And I decided to set the fictional tale in Las Vegas basically to set up the proposition of isn't this exactly what we should be doing?
Greg 00:40:40
Which is essentially creating a Las Vegas like mode to figuring out who gets what in terms of American health care services and geez, maybe that is a better answer than the stuff we're playing around with right now, which is money or that you're politically connected or God knows what other things we're we're going to come up with to figure out who gets those cancer drugs.
Greg 00:40:59
So I'm starting to think more and more about maybe that's right, that's scary.
Jesse Hirsch 00:41:04
I mean if you want to push it even further, it'd be like a cryptocurrency scam, right?
Jesse Hirsch 00:41:08
To see who gets the procedure, who gets the operation.
Greg 00:41:11
I think I've got my fifth book now.
Jesse Hirsch 00:41:13
Yeah, there you go.
Jesse Hirsch 00:41:15
You know, we, I like to end every meta views episode with shout outs.
Jesse Hirsch 00:41:21
Partly because, you know, we believe in the we stand on the shoulders of giants principle, but also because, you know, in the spirit of being intuitive, we like to throw to the guest and say, you know, who do you want to shout out?
Jesse Hirsch 00:41:34
Is there someone out there that you think deserves more recognition or that you want our audience to know more about?
Greg 00:41:41
In my books and now I would say that it's the same thing that for all the time I spend criticizing the health care system in America and around the globe, even.
Greg 00:41:50
It's the men and women who work in the healthcare system tirelessly, courageously, with all their hearts, in almost all cases, trying to do the right thing for people in a terribly flawed system that produces bad results many times that aren't their fault, but just getting up and continuing to do it.
Greg 00:42:09
They are the heroes of the pandemic.
Greg 00:42:10
They're the heroes of the.
Greg 00:42:12
Of our past, and they're going to be the heroes of the future, too.
Greg 00:42:14
And so God bless them for doing it.
Greg 00:42:16
It's probably work I wouldn't be capable of doing, but I've seen so many of them do it.
Greg 00:42:21
And I just have such respect for, for what they've done and what they contribute and what they give up in their own lives to be able to do that.
Jesse Hirsch 00:42:28
Right on.
Jesse Hirsch 00:42:29
Well, it kind of suggests maybe a future episode that we'll have to do, which is the future of health education, of how to make it easier for people who want to be that kind of hero to find the career, to find a job.
Jesse Hirsch 00:42:44
And I say this because, again, we're recording this on a Tuesday.
Jesse Hirsch 00:42:48
It'll air on the Wednesday where the provincial government, the Ontario government, is going to call an election.
Jesse Hirsch 00:42:53
And I think the biggest promise that the government is going to make is for more family doctors because we have a shortage of family doctors here in Ontario, like RFK Jr.
Jesse Hirsch 00:43:04
I don't think they're gonna follow through on that promise, but it's nice that they're floating it out there at least.
Jesse Hirsch 00:43:10
So, you know.
Jesse Hirsch 00:43:11
Thanks again, Greg, for joining us.
Jesse Hirsch 00:43:14
Thanks to everyone who followed along.
Jesse Hirsch 00:43:16
Meta Views is accessible on social media platforms.
Jesse Hirsch 00:43:21
We'll have links to Greg's book in the show notes or in the YouTube notes.
Jesse Hirsch 00:43:26
And we'll be back soon with hopefully more gripping, enthralling conversations about policy and why policy is so important to our lives.
Jesse Hirsch 00:43:36
I'm being a little facetious, but I'm not, and Metaview's listeners understand that.
Jesse Hirsch 00:43:41
So thanks again.
Jesse Hirsch 00:43:43
We'll see everybody soon.
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